American Journal of Infection Control: HCP/HCW Immunization, Coverage, Uptake

American Journal of Infection Control
Vol 41 | No. 8 | August 2013 | Pages 667-758
http://www.ajicjournal.org/current

Evaluating influenza vaccination campaigns beyond coverage: A before-after study among health care workers
Anna Llupià, Guillermo Mena, Victòria Olivé, Sebastiana Quesada, et al.
http://www.ajicjournal.org/article/S0196-6553%2813%2900847-X/abstract

Abstract
Background
Influenza vaccination campaigns based on educational interventions do not seem to increase coverage in the hospital setting, and their impact on educational goals is not usually evaluated. This study describes the campaign implemented in a university hospital and assesses the achievement of the strategic objectives, which were to increase health care workers (HCW) perceptions of the risk of influenza and of their role as promoters of influenza vaccination among their colleagues and to increase knowledge about influenza.

Methods
A before-after study was conducted using a self-administered survey in a randomized sample of HCW during the 2010-2011 influenza vaccination campaign. The Wilcoxon paired measures test was used to assess attainment of the strategic objectives.

Results
The campaign had a positive impact on the strategic objectives (Wilcoxon test, P value <.05 in all cases). The reach of the campaign was high (91.9%), and HCW rated it as positive (7.19 [standard deviation, 2.3] out of 10) but did not achieve increased coverage (34%; 95% confidence interval: 33.8-36.4).

Conclusion
Evaluation of the campaign shows that its effect responded to the strategic objectives. However, it seems that increasing the information provided to HCW and heightening their risk perception do not necessarily lead to greater acceptance of influenza vaccination.

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Predicting influenza vaccination uptake among health care workers: What are the key motivators?
Kimberly Corace, Chatura Prematunge, Anne McCarthy, Rama C. Nair, et al.
http://www.ajicjournal.org/article/S0196-6553%2813%2900114-4/abstract
Abstract
Background
Health care worker (HCW) vaccination was critical to protecting HCW during the H1N1 pandemic. However, vaccine uptake rates fell below recommended targets. This study examined motivators and barriers influencing HCW pH1N1 vaccination to identify modifiable factors that can improve influenza vaccine uptake.

Methods
A cross-sectional survey was conducted at a large Canadian tertiary care hospital. HCW (N = 3,275) completed measures of demographics, vaccination history, influenza risk factors, and attitudes toward pH1N1 vaccination. Self-reported vaccination was verified with staff vaccination records. Of the total sample, 2,862 (87.4%) HCW received the pH1N1 vaccine. Multiple logistic regression analyses were used to predict HCW vaccination.

Results
HCW attitudes toward vaccination significantly predicted vaccination, even after adjusting for demographics, vaccine history, and influenza risk factors. This model correctly predicted 95% (confidence interval [CI]: 0.93-0.96) of HCW vaccination. Key modifiable factors driving HCW vaccination include (1) desire to protect family members and patients, (2) belief that vaccination is important even if one is healthy, (3) confidence in vaccine safety, and (4) supervisor and physician encouragement.

Conclusion
This research identified fundamental reasons why HCW get vaccinated and provides direction for future influenza vaccination programs. To enhance vaccine uptake, it is important to target HCW attitudes in influenza vaccine campaigns and create a culture of vaccine promotion in the workplace, including strong messaging from supervisors and physicians

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Health care worker influenza immunization rates: The missing pieces of the puzzle
Susan Quach, Jennifer A. Pereira, Christine L. Heidebrecht, Jeffrey C. Kwong, et al.
http://www.ajicjournal.org/article/S0196-6553%2812%2901302-8/abstract
Abstract
Background
Immunization rates are used to assess the level of protection against influenza, but limited data exist on how such rates are measured in health care organizations. We conducted key informant interviews with campaign planners to learn about processes for collecting immunization data, including barriers and facilitating factors for measuring and reporting rates.

Methods
We conducted telephone interviews with 23 influenza immunization program planners across Canada working in 7 acute care hospitals, 6 continuing care facilities, and 8 public health organizations in 2012. We used content analysis to examine the interview data.

Results
The methods used to collect immunization data varied by the size and type of health care organization. Immunization data from different personnel groups were included in immunization rate calculations depending on the local public health reporting requirements and the organization’s size. Challenges associated with collecting immunization data and calculating rates included lack of resources for identifying personnel immunized off-site, tracking personnel who declined immunization, identifying non-payroll staff, and interpreting unclear public health reporting requirements.

Conclusion
Support from other vaccine providers, public health, employers, and professional and external bodies is needed to provide the necessary information and resources to calculate accurate and complete rates. Further work is needed to refine and standardize the collection of HCW influenza immunization data so that it may be used for surveillance and quality assessment purposes.

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Using a validated health promotion tool to improve patient safety and increase health care personnel influenza vaccination rates
Kevin Real, Sujin Kim, Joseph Conigliaro
http://www.ajicjournal.org/article/S0196-6553%2812%2901338-7/abstract
Abstract
Background
This study employed the risk perception attitude (RPA) framework to determine whether health care personnel (HCP) influenza-related risk perceptions and efficacy beliefs could be used to segment individuals into meaningful groups related to vaccination uptake, absenteeism, and patient safety beliefs.
Methods
After pilot interviews, a questionnaire was administered to 318 hospital-based HCP (80%) and nonclinical support staff (20%) in Lexington, KY, in 2011. Follow-up interviews were conducted with 29 respondents.
Results
Cluster analysis was used to create 4 groups that correspond to the RPA framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). A significant association was found between membership in 1 or more of the 4 RPA groups and the 3 study variables of interest: influenza vaccination uptake (F7,299 = 2.51, P < .05), influenza-related absenteeism (F7,269=3.6, P<.001), and perceptions of patient safety climate (F7,304=6.21, P<.001). A subset of respondents indicated the principal reasons for not getting vaccinated were “had one before and got sick anyway,” “concerned about vaccine safety,” and “no convenient time.” In follow-up interviews, HCP indicated that employee vaccinations were altruistic, increased herd immunity, and important for patient safety.
Conclusion
The RPA framework is a valid health promotion tool for improving patient safety, targeting specific groups for interventions, and improving HCP influenza vaccination rates.

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Impact of hospital policies on health care workers’ influenza vaccination rates
Mary Patricia Nowalk, Chyongchiou Jeng Lin, Mahlon Raymund, Jamie Bialor, et al.
http://www.ajicjournal.org/article/S0196-6553%2813%2900025-4/abstract
Abstract
Background
Overall annual influenza vaccination rate has slowly increased among health care workers but still remains below the national goal of 90%.
Methods
To compare hospitals that mandate annual health care worker (HCW) influenza vaccination with and without consequences for noncompliance, a 34-item survey was mailed to an infection control professional in 964 hospitals across the United States in 4 waves. Respondents were grouped by presence of a hospital policy that required annual influenza vaccination of HCWs with and without consequences for noncompliance. Combined with hospital characteristics from the American Hospital Association, data were analyzed using χ2 or Fisher exact tests for categorical variables and t tests for continuous variables.
Results
One hundred fifty hospitals required influenza vaccination, 84 with consequences (wear a mask, termination, education, restriction from patient care duties, unpaid leave) and 66 without consequences for noncompliance. Hospitals whose mandates have consequences for noncompliance included a broader range of personnel, were less likely to allow personal belief exemptions, or to require formal declination. The change in vaccination rates in hospitals with mandates with consequences (19.5%) was nearly double that of the hospitals with mandates without consequences (11%; P=.002). Presence of a state law regulating HCW influenza vaccination was associated with an increase in rates for mandates with consequences nearly 3 times the increase for mandates without consequences.
Conclusion
Hospital mandates for HCW influenza vaccination with consequences for noncompliance are associated with larger increases in HCW influenza vaccination rates than mandates without such consequences.

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Influenza vaccination knowledge and perceptions among Veterans Affairs nurses
Andrea R. Jennings, Christopher J. Burant
http://www.ajicjournal.org/article/S0196-6553%2813%2900104-1/abstract
Abstract
Flu vaccination among nurses in the Veterans Health Administration system is crucial in the prevention of influenza. Nurses working at a Veterans Administration Medical Center completed the Influenza Vaccination Knowledge and Perceptions Survey. The findings from this survey suggest the need for additional education for nurses as it relates to flu vaccination.

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A mandatory campaign to vaccinate health care workers against pertussis
Lisa M. Esolen, Kimberly L. Kilheeney
http://www.ajicjournal.org/article/S0196-6553%2812%2901341-7/abstract
Abstract
Pertussis is a highly contagious respiratory infection that has dramatically increased in recent decades and has caused outbreaks in health care facilities. Because of these trends, we implemented a mandatory pertussis (Tdap) employee vaccination program. Final vaccination compliance was 97.8% across all clinical campuses.

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Influenza immunization coverage of residents and employees of long-term care facilities in New York State, 2000-2010
Cara J. Person, Jessica A. Nadeau, Joshua K. Schaffzin, Lynn Pollock, et al.
http://www.ajicjournal.org/article/S0196-6553%2812%2901335-1/abstract
Abstract
We describe influenza immunization coverage trends from the New York State (NYS) Department of Health long-term care facility (LTCF) reports. Overall median immunization coverage levels for NYS LTCF residents and employees were 84.0% (range: 81.6%-86.0%) and 37.7% (range: 32.7%-50.0%), respectively. LTCF resident immunization coverage levels in NYS have neared the Healthy People 2020 target of 90% but have not achieved high LTCF employee coverage, suggesting a need for more regulatory interventions